1,6-二磷酸果糖心肌保护的研究进展

1，6-二磷酸果糖(FDP)在能量代谢过程中是葡萄糖及糖原氧化供能的重要中间产物，对于保证糖酵解顺利进行具有非常重要的意义，在临床得到普遍应用。除此之外，FDP还具有稳定细胞膜、减轻炎症反应、抑制氧自由基、抑制细胞凋亡等作用，对细胞结构及功能具有明确的保护作用。近年来FDP在心肌细胞保护及心脏功能恢复方面研究较多，也证明了其有效性，作者对此作一综述。     

奥沙利铂联合氟尿嘧啶和四氢叶酸钙对进展期胃癌病人术后辅助化疗效果

胃癌是我国常见消化道肿瘤之一,每年死亡人数高达30万,胃癌的治疗手术是根本,但术后大约40%病人会复发或转移,因此术后辅助化疗十分重要.而目前胃癌的术后辅助化疗无标准方案.2003年1月～2008年9月,我院收治接受奥沙利铂联合氟尿嘧啶和四氢叶酸钙(FOLFOX4)方案辅助化疗的进展期胃癌术后病人30例,本文对其临床资料回顾性分析如下.     

高血压伴肥胖和高血压非肥胖患者胰岛β细胞早期分泌相的改变

为了解高血压伴肥胖者（ＯＨＴ）和高血压非肥胖者（ＮＯＨＴ）胰岛β细胞早期分泌相的变化规律，用左旋精氨酸（Ｌ－ＡＲＧ）刺激法，对ＨＴ患者胰岛β细胞分泌功能进行了研究。结果：（１）空腹胰岛素（ＩＮＳ）、Ｃ－肽（Ｃ－Ｐ）值ＯＨＴ组明显高于对照组和ＮＯＨＴ组（Ｐ＜０．０５或Ｐ＜０．０１），后两者间无明显差异（Ｐ＞０．０５）。（２）Ｌ－ＡＲＧ兴奋后ＯＨＴ和ＮＯＨＴ组ＩＮＳ和Ｃ－Ｐ分泌在４分钟时达峰值，而对照组２分钟达峰值。（３）Ｌ－ＡＲＧ兴奋后ＩＮＳ和Ｃ－Ｐ各时点增加值的和（△∑）以ＯＨＴ组明显高于对照组和ＮＯＨＴ组，后两者无显著差异。（４）ＯＨＴ组△∑ＩＮＳ与ＤＢＰ和体重指数（ＢＭＩ）均呈明显正相关（Ｐ＜０．０５），而ＮＯＨＴ组多元回归分析未发现△∑ＩＮＳ与ＤＢＰ和ＢＭＩ有相关性。结果提示ＯＨＴ患者存在胰岛素抵抗（ＩＲ），Ｌ－ＡＲＧ刺激胰岛β细胞早期分泌相是增加的；ＮＯＨＴ患者ＩＲ不明显。ＩＲ是ＯＨＴ发病的原因之一。     

宣肺化痰柔肝祛风法治疗小儿咳嗽变异性哮喘42例

咳嗽变异性哮喘是一种潜在隐匿特殊类型的哮喘。以咳嗽为主要症状,病程迁延,反复不愈,临床上容易误诊误治,抗生素及常规止咳药基本无效。笔者近年来运用宣肺化痰、柔肝祛风法治疗该病,取得了较好的疗效,现报道如下。1临床资料取材于2003年6月—2005年6月本院儿科门诊典型完整病     

补肾祛斑颗粒治疗黄褐斑的血清药理学研究

目的通过体外实验阐述补肾祛斑颗粒治疗黄褐斑的血清药理学作用机制。方法按临床用量的24,12,6倍作为本实验的高、中、低剂量组对大鼠灌胃并提取含药血清,对照组灌入生理盐水。A375和B16细胞作为本实验的研究对象,含药血清处理24 h、48 h和72 h后检测细胞活性、黑色素含量及酪氨酸酶活性。结果补肾祛斑颗粒含药血清能明显促进A375和B16细胞增殖且呈浓度依赖和时间依赖效应。其能显著抑制细胞内黑色素含量及酪氨酸酶活性。结论补肾祛斑颗粒通过抑制细胞内酪氨酸酶的活性抑制细胞内黑色素的合成,从而起到治疗黄褐斑的药效。     

某院328张急诊处方抗菌药物的统计分析

目的了解医院抗菌药物使用的近况。方法抽取2012年1月至2012年2月急诊处方328张,针对抗菌药物的处方进行统计分析。结果含有抗菌药物的急诊处方126张,使用率为38.41%,抗菌药物处方含有1～3种抗菌药物分别为98、25、3张,分别占抗菌药物处方的77.78%、19.84%、2.38%;静脉用药占41.27%,口服给药占50.79%,结果表明,我院抗菌药物使用率出现下降,静脉给药比例出现下降,但是存在经验性抗菌药物的使用指征不明确,抗菌药物用法不规范,联合应用抗菌谱相重叠。结论急诊医师开具抗菌药物处方时应兼顾抗菌药物的药动学抗菌活性、抗菌谱与联用机制。     

"杂交"手术治疗DeBakey Ⅰ型主动脉夹层

目的 总结应用无深低温停循环的升主动脉置换、升主动脉-主动脉弓分支血管旁路、腔内隔绝的"杂交"手术治疗DeBakey Ⅰ型主动脉夹层的方法和经验.方法 2009年1月至2010年6月,39例、平均年龄(55±16)岁的DeBakey Ⅰ型主动脉夹层病人进行无深低温停循环的"杂交"手术.病人经股动脉、右腋动脉插管灌注,先于常规体外循环下行升主动脉和主动脉瓣置换,再采用四分支人工血管、"Y"形人工血管或单根人工血管行升主动脉-主动脉弓分支血管旁路手术,再经股动脉逆行径路数字减影血管造影(DSA)下或术中顺行径路食管超声定位下行主动脉弓-降主动脉腔内隔绝术.结果 全组均手术成功,升主动脉处理时8例行单纯升主动脉人工血管置换,20例行Bentall手术(其中冠状动脉移位采用Carbrol法11例),11例行Wheat手术;升主动脉-主动脉弓分支血管旁路手术采用四分支人工血管16例、"Y"形人工血管15例、单根人工血管序贯法8例;主动脉弓-降主动脉腔内隔绝术采用DSA下股动脉逆行径路36例,术中人工血管分支顺行径路3例,均使用1枚支架.体外循环(61±22)min,主动脉阻断(48±18)min.术后(30±9)h拔除气管插管,24 h胸液小于300 ml,无偏瘫、截瘫、严重感染、凝血障碍等并发症.所有病人均治愈出院,平均术后(21±6)天出院.术后随访1～15个月,平均(8.4±7.2)个月,病人均健康生存,无脏器功能不全.术后3个月行CT主动脉血管成像检查,显示膈肌水平假腔闭合率为91.2%.结论 常温体外循环下升主动脉置换、升主动脉-弓部血管旁路、腔内隔绝的"杂交"手术治疗DeBakey Ⅰ型主动脉夹层,简化了DeBakey Ⅰ型主动脉夹层外科治疗方法,该手术方法避免了深低温停循环,减少了术后并发症,提高了外科治疗效果.

Abstract：

Objective Some major procedures for DeBakey type Ⅰ aortic dissection used to be performed with deep hypothermic circulatory arrest, which had been associated with more complications than seen with standard extracorporeal circulation. We reviewed the cases who received the treatment for DeBakey type Ⅰ aortic dissection by hybrid procedure without deep hypothermic circulatory arrest. The procedure consisted of ascending aorta replacement, ascending aorta-aortic arch branch vascular bypass reconstruction and endovascular graft exclusion. Methods From January 2009 to June 2010, 39 patients [mean age (55 ±16) years] who had DeBakey Ⅰ aortic dissection underwent hybrid procedure without deep hypothermic circulatory arrest. The femoral artery and right axillary artery were cannulated for perfusion. The ascending aorta and/or aortic valves were replaced under conventional extracorporeal circulation with Bentall procedure or Wheat procedure. The aortic arch branch vessels were dissected and the proximal part was sealed. Then the ascending aorta-aortic arch branch vascular bypasses were constructed with 4-bifurcation vascular grafts, Y-shape bifurcated vascular grafts or artificial vessels. Finally the endovascular grafts were deployed via the femoral incisions monitored dynamically with DSA, or via the ascending aortic bifurcated vessels monitored with transesophageal echocardiography. Results The operation succeeded in all 39 patients. Eight patients underwent ascending aorta replacement without aortic valve replacement or prosthesis, 20 patients underwent Bentall procedure ( Carbrol procedure were used in 11 cases), and 11 underwent Wheat procedure. For ascending aorta-aortic branch vascular bypass reconstruction, sequential anastomoses were performed in 8, Y-shaped bifurcated grafts were used in 15, and 4-bifurcated grafts were employed in 16 patients. The endovascular stent grafts were deployed via the former femoral incisions in 36 patients and via ascending aortic bifurcated vessels in 3. The cardiopulmonary bypass time was (61 ±22) minutes, the aortic crossclamp time was (48 ±18) minutes, and the post-operative intubation time was (30 ±9) hours. The thoracic drainage from each patient was less than 300 ml in 24 hours. No complication, such as hemiplegia, paraplegia, severe infections, renal failure or coagulation disorder, was observed. The duration of hospitalization was (21 ±6) days. No hospital death occurred. Follow-up was performed 1 to 15 months [mean (8.4 ±7.2) months] postoperatively. All patients survived without any organ dysfunction at follow up. The CTA examination 3 months after operation revealed that the false lumens had been closed in 91.2% of the patients. Conclusion Our findings indicated that the hybrid procedure, which combining ascending aorta replacement,ascending aorta-aortic arch branch vascular bypass reconstruction and endovascular graft exclusion under conventional extracorporeal circulation, may be an option for avoiding the possible complications associated with profound hypothermic circulatory arrest. The novel hybrid operation may improve the surgical outcomes and provide a simplified surgical approach for the treatment of DeBakey Ⅰ aortic dissection.     

吉非替尼二三线治疗晚期非小细胞肺癌的临床观察

目的 观察吉非替尼单药对既往化疗失败的临床晚期非小细胞肺癌的疗效和毒副反应.方法 36例既往化疗失败的晚期非小细胞肺癌患者,口服吉非替尼250mg,每日1次,直至病情进展停药,至少1个月以上评价疗效.结果 36例中晚期非小细胞肺癌中,全组总有效率25%(9/36),其中CR 0例,PR 9例,SD 14例;疾病控制率63.89%(23/36);中位生存时间8.7个月,1年生存率30.56%;不良反应主要为皮疹Ⅰ～Ⅱ度44.44%,腹泻Ⅰ～Ⅱ度27.78%,恶心、呕吐Ⅰ～Ⅱ度19.44%.结论 对既往(一线、二线)化疗失败者应用吉非替尼作二线、三线治有很好效果,毒副作用低且耐受好.